Landmarks Preservation Commission work application form F-2, undated

NYC 9111 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION • • ~a9 I CENTRE STREET. 9TH FLOOR. NEW YORK, NEW YORK.10007 ., .•, TEL: (212) 669- 7700 FAX: (212) 669-7960

APPLICATION FORM F-2 FOR WORK ON DESIGNATED PROPERTIES This application will not be deemed complete until It is so certified by the Landmarks Preservation Commission. An application consists of an application form and the materials necessary to describe the project fully. If being submitted in response toe Warning Letter or Notice of Violation, please enter the number below. Please print or type all Hems. If not applicable, mark NA.

PC DOCKET I DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. C & DATE STAFF

❑ INDIVIDUAL ❑ SCENIC ❑ INTERIOR WE Of DESICSNATION HISTORIC DISTRICT

PMW O CNE 0 C OF A 0 REPORT CTION OTHER WORK TYPE

Exterior ADDRESS FLOOR OR AMRTMENt DESIGNATED PROPERTY Manhattan BOROUGH BLOCK LOT ZONING DETAILED Removal of debris (cleaning) from the collapse of the.WTC OF PROPOSED WORK from exterior building surfaces as per scope of work Use back of form if necessary previously reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAME, TALE& FIRM(i applicoWel Pt-IONE ldot CO-OP SHAREHOLDER ADDRESS APT R CRY• STATE. ZIP CODE

NIA ARCHITECT/ NAME. TITLE & FIRM Ill oppilcoblel PHONE (dayl ENGINEER If applicable ADDRESS CITY. STATE ZIP CODE Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR NAME TITLE & FIRM (It applicable) PHONE (day) If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CITE STATE ZIP COL)

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME TITLE & FIRM (If apdicobiel PHONE loan e.g. Expeditor. Attorney. Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona New Ynrk 11368 ADDRESS CITY, STATE ZIP OT_

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department 0 City Planning Commission ❑ Board of Standards & Appeals

I am the owner of the above listed property. lam familiar with the work proposed to be carried out on my property and give my permission for this application to be riled. The information entered is correct and complete, to the best of my knowledge. OWNER For applications for work on or In a cooperaWe or Condominium building. OWNERS NAME and TITLE Ipleoae type or print) PHONE (dafT tire owner is the Co-op Board or Condominium Association. An office, of the Co-op Board or Condomnum COMPANY CORPORATION- ORGANIZATION (R applicable) Association must sign this application. Please consult the Instructions for Bong for additional Information. ADLEITESS Cflf STATE. ZIP CODE

NYC DEP for owner SIGNATURE SIGNATURE OF OWNER

Note: Section 25-317 of the Administrative Code of the City of New York makes it a punishable offense to willfully make false statements on this application.

NYC-WTC000093885